Episode 15 – How to Find Meaning in Your Work

Welcome to episode fifteen of the Ausmed Handover podcast. For so many nurses, their career will follow a familiar trajectory. As a new graduate, their world is exciting and driven by the challenges associated with applying their theoretical knowledge to a practical context, but over time, the unrelenting pressure, absence of positive feedback, and lack of clearly satisfying outcomes, leaves many nurses jaded, frustrated and frequently questioning if what they do has any real meaning. In this episode, I’ll be looking at how one man was able to find meaning in the most horrific and hopeless of circumstances, and how his ideas can change the way you perceive your work.

Transcript

INTRODUCTION (00:10)

Hello and welcome to the Ausmed Handover Podcast. My name is Darren Wake, and if you’ve lost your way in the profession and are jaded, dissatisfied and unhappy, this is the episode for you.

No matter what you do or where you work, I’m going to help you find the meaning in your work again.

MUSICAL BRIDGE (00:10)

In this episode, we’re going to be talking about the why of your nursing, rather than the how.

The ‘why’ question is how we identify the personal meaning of our work.

Why you are a nurse is not just one of the many important questions you should be asking yourself about your nursing career, it is by far the most important, as it is absolutely and inseparably linked to how you perceive your value as a nurse. In the context of this podcast, meaning and value are pretty much the same thing.

Continue Reading Transcript

If you don’t feel valued as a nurse, then I suspect you are having trouble finding meaning in your work, and consequently question or doubt the purpose of everything that you do.

Conversely, if you feel valued as a nurse, then I suspect that you have indeed found meaning in your work, and so understand the purpose of almost everything that you do.

I can’t emphasise enough the importance of the question “why am I a nurse?”. If it can’t be answered, if you can’t state definitively why you go to work every day, then you’re in the middle of an existential crisis, and you really need to do something about it.

An existential crisis is where we fail to find meaning in our lives or our work, and it can have catastrophic consequences. In psychological and philosophical terms, it’s the moral equivalent of a cardiac arrest: if action isn’t taken immediately to fix the situation, then the outcomes are rarely, if ever, good.

What happens if you don’t do something about it? Well, we’re going to talk more about that in a moment, but I can absolutely assure you that after 35 years as a nurse, I’ve never seen a case of serious burnout that wasn’t preceded by an existential crisis, and in that, I mean those colleagues of mine that suffered instances of catastrophic burnout did so because they simply couldn’t find an answer to the question: “why am I a nurse?”.

When there’s no clear answer to that, or if the answer is obscure or unclear, or even a lie, then our actions have no clear purpose; there’s no meaning associated with what we are doing, and meaningless work is absolutely soul destroying.

And that’s because human psychology has a range of inviolable laws that can’t be bucked. That is, laws that are kind of hard wired into our thinking at either at the conscious or subconscious level, and many of which are so sacrosanct as to actually define us as human beings.

The foremost of these laws is that what we do must have meaning. That is, our actions in a given situation must contribute to some greater goal other than just the act in itself.

When this is not the case, then we are reduced to a day-to-day, minute-by-minute existence, concerned only with the most basic and physiological her and now. And that’s just not fulfilling.

This is such an overt part of our existence that for almost 4,000 years it’s been recognised that much of our lives will indeed be spent in a search for meaning – which, for everyone, will be a completely unique and very individual experience – and although many people find the meaning they are searching for – that is, something that gives their life purpose – many more don’t, and consequently lead lives of unbearable drudgery and sorrow and in the end always describe their existence as ‘unfulfilled’.

But everyone has the opportunity to find the meaning they are looking for. They often just look in the wrong places.

If you can make a simple statement describing why you are a nurse – “I’m a nurse because…” – then you have articulated both purpose and meaning in a single sentence, and you may not need what I have to say in this podcast. But I suspect that a lot of you are questioning on an ever increasing basis, just why you go to work every day and do your job.

My purpose in writing this episode is to resurrect those of you who believe they are professionally dead and help you find meaning in your work again.

Why? Because I don’t think that there is a single nurse on this planet that isn’t absolutely essential to the continued health and welfare of the human race, and that includes you.

MUSICAL BRIDGE (00:10)

For most of us, when we enter the nursing profession, we do so because we have a purpose in mind. That is, nobody becomes a nurse without believing that somehow, nursing will be the nexus to bring meaning into some aspect of their lives.

If you’re not clear on this, then ask yourself the historical question: “why did I become a nurse?”

At the time, most of you will have said:

“To help people” …

But just as many might have said:

“I wanted a career that would take me around the world” …

And still others might have said:

“I wanted job security” …

or

“I wanted a well-paid job”.

And probably countless other reasons.

Whatever… we all entered the profession because we believed, at the time, it would serve a certain purpose. No one, absolutely no one, became a nurse without a reason, no matter how trivial or important that reason might have seemed at the time. No one embarked on three years of gruelling study by accident.

Now, what’s important to realise is that in many of the answers I listed above, the meaning isn’t overtly stated, but it’s implied.

Someone who says “I wanted a career that would take me around the world” is really saying that travel and experiencing new cultures is what brings meaning into their lives, and nursing serves the purpose of facilitating this.

You get what I mean.

We all start nursing with a purpose in mind, but for most, if not the very large majority of us, the meaning that purpose serves changes over time, and often, it becomes difficult to link purpose and meaning, or even be clear what the meaning is.

I stated earlier on that if you can complete the statement “I am a nurse because … “ then you have linked purpose and meaning together, and despite what you think, you’re in pretty good shape.

However, if you’re saying things like “I don’t know why I come to work every day” or “I don’t know why I am a nurse anymore” then for you, the meaning of your nursing is either lost, no longer relevant, or completely obscured.

So how does this happen?

Well, it’s a really common phenomena, and not just in nursing – it’s endemic to all professions, jobs and cultures, so let’s look at some of the main reasons why.

MUSICAL BRIDGE (00:2)

We entered into a vocation that doesn’t complement our nature. That is, we started nursing because either we were expected to, because we didn’t know what else to do with ourselves, because we didn’t really understand what the job involved but it looked pretty good anyway, and finally, because we couldn’t get into any other courses and we were expected to or wanted to get some kind of a qualification.

These are all cases where we enter into a profession to satisfy someone else’s expectations. That someone being friends, family, or even society as a whole.

That’s fine, and in such cases nursing serves a purpose, but it’s only temporary. Once the qualification has been gained and you can use that RN title after your name, then that purpose has been satisfied, and the remainder of your career will become a long, hard grind to find an alternative purpose for your work.

The second main reason, and this is entailed in the first, is that whatever meaning we found originally through the profession has been satisfied, or exhausted, and we find that our work no longer serves its original purpose.

A good example of this will be the person who enters nursing because it affords them the opportunity to travel and see other cultures – something that gives their life real meaning. But one day, they buy a house, settle down and start a family, and their priorities change, as does what gives their life meaning. Suddenly, nursing no longer provides a means for travel, but rather the shift work, culture and physical demands become a burden on their new lifestyle.

The third main reason is one I see every day in my work. I think a huge proportion of the profession became nurses because they wanted to help people. But in order to validate that we are doing that, we need to see outcomes that are meaningful. That’s a phrase that’s bandied about a lot, but what it means is that you need to see regular proof that what you are doing is genuinely helping those you care for.

If you work somewhere like an emergency department, it seems that there are more often occasions to have your purpose validated. Perhaps you assist in the successful resuscitation of a child, or ease the pain of someone with a broken arm. Or in palliative care, where you can assist someone in their dying moments to make it as pain-free and comfortable as possible.

Such areas provide clear and obvious end points to your care; it was either good, or it wasn’t, and presuming all your care is good, you get regular validation of your purpose, and consequently, it’s a lot easier to find meaning in your work.

However, many of us, if not the majority of us, don’t work in environments of near instant validation; the outcomes we see are obscure, vague, indiscernible. We might see people discharged from the wards, but we rarely hear about how they do once they have returned home. This, coupled with the massive number of our clients who, despite decades of preventative health advice, still choose to make monumentally self-damaging and often fatal lifestyle choices, means that we rarely see proof that our work has purpose.

But it’s also more complex than this. Since we rarely find out whether we genuinely helped those in our care, we often look to our colleagues for validation that the care we gave was of a good standard.

Regrettably, nursing has a culture where this feedback is rarely given and negative criticism is common, and so we find ourselves without any yardstick to measure our care by, and if we have no evidence that our care was beneficial, then it becomes increasingly difficult to find purpose in our work.

We start hearing phrases from nurses like “why am I doing this?” or “I’m just going through the motions”, which all indicate to me that the meaning in their work has been lost. That their nursing, in their eyes, no longer serves a purpose.

And this is incredibly damaging to both the person and the profession. To the person because doing work without purpose is soul destroying, and to the profession because if a person cannot find purpose in their work, they have no reason to believe that any standard need be met, and the quality of their work will decline catastrophically.

MUSICAL BRIDGE (00:10)

So what’s it like to be at a point where you simply can’t find meaning in your work?

Well, at one end of the existential crisis scale, it means at the very least that coming to work for you will be a real burden; a barrier between you and those things in your life that do have meaning. You’ll be unhappy, difficult to work with, and constantly questioning the purpose of what you are doing and always, always dreaming of being in some other career.

One friend of mine in this position described walking to work as feeling that a kilogram of lead was placed on her shoulders with every step she took closer to the front door of the hospital.
At the other end of the scale, at the level of profound crisis, thoughts of suicide and sheer panic start to intrude into our thoughts.

Despair, I think, is the most appropriate term to describe this phenomenon.

I can’t emphasise enough that not being able to find meaning in your work really can result in a crisis this severe. I’ve been a nurse for 35 years, and during this time, 3 of my colleagues have committed suicide, and they did this because they felt that they had dedicated their lives to the profession but found that they simply couldn’t find any purpose in anything they did anymore. They loved nursing, they had a clear idea of the purpose it served, but they were unable to find any kind of validation from either their patient outcomes or their colleagues that what they were doing was good and meaningful. That is, they received no evidence that what they were doing actually helped people.

So if you can’t find meaning in your work, if you are constantly saying “why am I doing this, what’s the purpose?”, what can you do?

Well, there are three options.

Firstly, you need to consider if nursing has served its purpose. That is, the meaning you originally sought from it has been fulfilled. As such, you need to consider if it’s time to pursue another profession.

Secondly, you need to consider if the environment you work in represents a barrier between you and your purpose. That is, maybe changing to an area that is more likely to provide you with evidence that what you do has purpose. If you’re on a ward full of bullies and receive nothing but negative feedback, find a ward where positive feedback is more freely given. If you work on a ward where you never really see any improvement in your patient’s lives, find somewhere where the evidence is provided rapidly, like recovery or emergency, or even midwifery.

But OK, these two solutions are simplistic. I know that a lot of us can’t quit the profession, can’t up stakes and move to another hospital, and there’s always the maxim of ‘the devil you know’ when it comes to changing wards.

In such cases, you have one option, and one option only: you need to take control over your attitude to your situation. To find meaning in your work again, you need to either alter how you link purpose and meaning, find a different meaning altogether, or change how you validate your meaning.

A long time ago, the psychiatrist Viktor Frankl said that if a person knows the why, then they can tolerate the very worst of hows. Frankl is worth listening to – he survived three years in Auschwitz because of this maxim, and a lot of what I write here is based on his work.

If you have a clear understanding of why you are doing nursing, then no matter what the environment is like in which you work, you’ll be able to deal with it (take my word about this). The critical secret is to find a why that suits you, and it’s rarely where you are looking.

Most of us, I would think, have at some stage suffered a lack of purpose because we never really get to find out if what we are doing results in any good. For others, it’s because they no longer wish to travel the world, others again because they have met the challenge of obtaining a qualification and so forth. Whatever, we have lost sight of our purpose, or our purpose is no longer relevant, and we want to find meaning in our work again to make it worthwhile.

So, why is it so hard to find a new purpose and meaning in what we were doing?

Well, it’s not: rather it’s because we are looking in the wrong places. Once the meaning of our work has been lost to us, many of us will fumble and grasp at the greater purpose of the profession as if it should be our own; that is, that the purpose of nursing is to help the sick. But this isn’t necessarily where we will all find meaning, and it doesn’t suit us all.

Helping the sick and so forth is the purpose of the profession, and that’s fine, but it doesn’t have to be yours, and there’s no shame in changing the purpose of your work to serve a meaning that is centred around yourself and your own interests.

And it doesn’t matter to the profession either. It’s the collective effort of nurses working within the policies, procedures, guidelines and codes of the profession that allows the profession to pursue its own purpose. And as long as you are adhering to these codes, policies, guidelines and procedures, the profession as a whole will achieve its purpose and it doesn’t care what your personal purpose is, or how you find meaning in the job.

And this is an incredibly liberating thing.

So you’re free really to attach any kind of purpose you like to your work. You just have to free yourself of the greater purpose of the profession and ask: “Why do I come to work every day?” and realise that there’s no shame or guilt whatsoever attached to your answer.

If you come to work for money, that’s OK, the money allows you to pursue the life of your choice, or feed your children, or take them on holidays, or allows you to indulge yourself in your favourite hobby or pastime, or even regularly entertain yourself.

I come to work to be with my friends. If you come to work to be with your friends, that’s OK. It’s a legitimate personal reason to come to work.

You come to work to get away from my family? That’s OK too.

What I’m saying is that if you can’t find meaning in your work, think again; you’re probably under the false illusion that it somehow has to cohere with the grander purpose of the profession.

But it doesn’t – it can be as selfish as you want, so long as you are working within the expectations of your employer and the profession, the greater purpose of nursing will take care of itself. But if you can find one reason to show up at work every day, then you have a starting point to find meaning in your work again. You just don’t have to look at the traditional indicators of the profession that validate your purpose, look at the ones that reflect your personal meaning (like whether your family enjoyed their holiday or not, or if you enjoy the company of your work friends and so forth).

The next way to find meaning is to redefine the way you measure if you are achieving your purpose or not. In many ways, this is what I’ve just been talking about in the preceding section. It may just be that the same meaning that you found in your work originally is still there for you, you are just measuring it with the wrong yardstick.

So if, for instance, your purpose in doing nursing is to help people, and these days you work on a ward where it is very difficult to see if you are achieving this or not, then don’t look at the level of the individual patient, look at the broader statistics. Are the kind of people I am looking after living longer, better lives, are readmission rates for these kinds of people falling?, and so forth.

These statistics are easily accessible and valid bench marks, and the only way they change is by people such as yourself doing the hard yards every day. If you can see that they are improving, then you have confirmation that your job has real meaning, and you’re making a difference.

The final way I’m going to suggest involves shifting from the external to internal validation.

Most of us seek external validation of our purpose, and this is ingrained into the many aspects of the profession. When we train, we have objectives to meet, and our purpose is validated by meeting them. When we finish our training and enter the workforce, we have certain standards to meet, and these are measured regularly, and we receive informal feedback as to the quality of our work.

However, over time, the feedback received tends to fall off, and it generally only comes in a negative form, so if we have no external means of validating our work, our purpose, then we need to look to internal benchmarks.

People who use internal validation tend to move to the beat of their own drum, but make no mistake, they have the most robust system of purpose and meaning amongst us.

But it’s not easy to do. You have to devise your own set of internal benchmarks that tell you you are achieving your purpose. In the absence of any positive feedback from your peers or patients, then you can rely on this to tell you that you are doing a good job.

The simplest one I have ever heard someone to use (and this is someone whose stated purpose was to help people) is that if they thought that at the end of the day they had given out all their medications correctly and they had done all the clinical care required and within policy and guidelines, then they felt that they had contributed to the health and wellbeing of their patients, and they didn’t need any feedback or statistics to assure them of this.

MUSICAL BRIDGE (00:10)

Finding meaning in your work as a nurse is absolutely critical both for yourself, the profession and the people you care for. If meaning can’t be found, then the consequences can be catastrophic, but meaning can be found, and found on even the most awful of clinical environments and amongst even the worst of staff. It just takes a simple change of perspective (which is easier said than done, I know), but working with a nurse that understands the purpose of their labour, that is, knows the meaning of what they are doing is gold, and there’s no reason you can’t be like that. It will change how you feel about going to work every day, increase the quality of your work, and make you a real asset to the profession.

This is the Ausmed Handover podcast, my name is Darren Wake, and thank you for listening.

If you enjoyed this podcast, please subscribe to the channel for future episodes, and feel free to leave your comments and feedback for us; we always welcome your opinion.